There are several therapies that are effective in treating personality disorders. Cognitive behavioral therapy helps the patient identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Dialectical behavior therapy is a type of cognitive behavioral therapy that teaches behavioral skills to help tolerate stress, regulate emotions and improve relationships with others. Psychoeducational and Structural family therapy
CBT for personality disorders CBT conceptualizes all 10 personality disorders as dysfunctional core beliefs about the self, others and the world. The cognitive therapist helps people with these disorders learn to identify and change these core beliefs To change dysfunctional beliefs like, "Im defective, helpless, vulnerable and bad,” the therapist must help patients revisit and reinterpret early childhood experiences. Therapists ask patients to move beyond thinking of such events as proof of inadequacy and instead explore alternative meanings. A challenge for CBT therapists is that patients with personality disorders do not come into therapy ready to trust. Therapists should be ready to help patients examine dysfunctional beliefs about the therapist or therapy. ALL previous slides on CBT should be reviewed and sections read.
DBT Dialectical Behavior Therapy (DBT) has been found to be very effective in treating most personality disorders, mainly BPD. It is a modified CBT. DBT seeks to teach the client how to learn to better take control of their lives, their emotions, and themselves through self-knowledge, emotion regulation, and cognitive restructuring. It is a comprehensive approach that is most often conducted within a group setting. Because the skill set learned is new and complex, it is not an appropriate therapy for those who may have difficulty learning new concepts.
A key assumption in DBT is that self-destructive behaviors are learned coping techniques for unbearably intense and negative emotions. Negative emotions like shame, guilt, sadness, fear, and anger are a normal part of life. However, it seems that some people are particularly inclined to have very intense and frequent negative emotions. It could be the way their brain functions, it could be due to severe emotional or physical trauma Additionally, sometimes clients have mood disorders that are not controlled by standard medications and thus lead to emotional suffering. A Any one of these can lead to a problem called emotional vulnerability. A person who is emotionally vulnerable tends to have quick, intense, and difficult-to-control emotional reactions that make his or her life seem like a rollercoaster. Extreme emotional vulnerability is rarely the sole cause of psychological problems. An invalidating environment is also a major contributing factor. What is an invalidating environment? The “environment,” in this case, is usually other people. “Invalidating” refers to a failure to treat a person in a manner that conveys attention, respect, and understanding. Examples of an invalidating environment can range from mismatched personalities of children and parents (e.g., a shy child growing up in a family of extraverts who tease her about her shyness); to extremes of physical or emotional abuse.
Clients in standard DBT receive three main modes of treatment – individual therapy, skills group, and phone coaching. In individual therapy, clients receive once weekly individual sessions that are typically an hour to an hour-and-a half in length. Clients also must attend a two-hour weekly skills group for at least one year. In group patients learn four sets of important skills – Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Clients are also asked to call their individual therapists for skills coaching prior to hurting themselves. The therapist then walks them through alternatives to self-harm or suicidal behaviors. It should be noted that in standard DBT, it is the individual therapist who is “in charge” of the treatment. This means it is the individual therapist’s job to coordinate the treatment with the other people – skills group leaders, psychiatrists, and vocational counselors. In collaboration with the client, the therapist keeps track of how the treatment is going, how things are going with everyone involved in the treatment, and whether or not the treatment is helping the client reach his or her goals.
Family Therapy Component Structural approach: Family as a whole organism, a system that presents its own rules. These rules define the organization of the family. Process Vs. Content: The family therapist needs to pay attention to the interactions that occur among family members (the process) not to what they talk about (content) in order to understand the organization.
The focus of structural family therapy follows this order: 1. Joining and accommodating 2. Assessing family interactions 3. Monitoring family dysfunctional sets 4. Restructuring transactional patterns
Psychoeducational family therapy It is important that the patient and the family become knowledgeable about the patient’s symptoms. It is important that family members learn to provide guidance to the patient when they feel frustrated because of their symptoms. The therapist should monitor medication use. Previous slides and readings on this type of family therapy should be reviewed.
Eating disorders There are several treatments that work well with eating disorders. They are CBT DBT Family therapy Group therapy
CBT CBT is widely used in counseling for eating disorders to change the way patients think about their bodies and their relationship with food. CBT helps patients understand how their thinking and negative self-talk and self-image can directly impact their eating and negative behaviors. CBT focuses on the present and is an active and practical approach for solving problems and changing self-defeating thought patterns. With new skills, patients are able to reduce eating disorder symptoms, recognize triggers and avoid relapse. Cognitive-behavioral therapy will often focus on identifying and altering dysfunctional thought patterns, attitudes and beliefs, which may trigger and perpetuate the person’s restrictive eating. At the foundation of CBT is helping a patient understand, identify and change their irrational thoughts, and helping a patient make the changes real through specific behavioral interventions (such as promoting health eating behaviors through goal setting, rewards, etc.). Review all CBT slides and reading.
DBT Another effective therapy used to treat eating disorders is Dialectical Behavior Therapy, or DBT. DBT is designed to teach patients new coping strategies to more effectively handle difficult emotions. Rather than turning to eating disorder behaviors, patients develop a set of life skills they can draw from for lasting recovery. The four DBT skill sets are: Mindfulness – Staying present in the moment with a deep awareness of one’s thoughts, feelings and actions. Rather than judging a thought or feeling, mindfulness practice helps patients learn to accept whatever they are experiencing in a given moment. With greater awareness, patients are better able to regulate their thoughts and feelings and shift their attention in another direction when their thought pattern is becoming unproductive or unhealthy. Distress Tolerance – Learning to accept distress and other difficult emotions that are an inevitable part of life, rather than resorting to eating disorder behaviors. Part of distress tolerance is delaying gratification and avoiding impulsive behaviors, and finding healthier ways to cope such as self-soothing, distracting, and assessing pros and cons. Emotion Regulation – Identifying emotions and working to let go of painful feelings to make room for positive ones. Interpersonal Effectiveness – Improving interpersonal relationships by increasing assertiveness and communication skills. Some of the skills patients learn include asking for what they need, setting healthy boundaries, and coping with conflict effectively without hurting others or jeopardizing their self-respect.
Family Therapy Eating disorders affect the entire family, causing frustration and concern and drawing attention away from siblings. Recovery isn’t an isolated event, it takes time and involves the family. Studies show that family involvement is essential for successful eating disorder recovery, particularly for teens. In family therapy, patients have the opportunity to discuss underlying issues and conflicts with their family in the presence of an objective therapist. The goals of family therapy are to: Educate family members about eating disorders and the recovery process Instill new conflict resolution skills and communication strategies Prepare family members for the patient’s return home (if applicable) Help family members learn how to support their loved one’s recovery Connect with other families to share stories and support (multi-family therapy) Ensure that family members have a support network of their own and a healthy sense of self With guidance, families can take care of their own needs while offering support and encouragement for their loved one.
Family Therapy Family therapy is usually conducted with the person who has anorexia and their family. However, in some instances, a few family therapy sessions may involve therapy without the person who has anorexia present. This may help the family understand the roles they are playing in supporting the disordered eating, and suggest ways the family can help the person with anorexia acknowledge the problem and seek out treatment. Family therapy helps a person with anorexia see and understand the often-times dysfunctional role they play within the family, and how their eating behaviors maintain that role.
Group Therapy Group therapy is a critical aspect of eating disorder treatment. For many people, hearing about the experiences of others and receiving honest feedback from people who are facing similar struggles is one of the most beneficial aspects of treatment. In a safe, nurturing setting, patients share their pain and in doing so, realize that they are not alone. The relationships that develop in the group can build self-esteem and serve as a model for trusting, supportive relationships. The group setting is also a safe place to practice new communication skills and the art of acceptance of both self and others. In group therapy, patients help one another identify and resolve problems with the guidance and expertise of a professional therapist. With a spirit of caring, they can question each others distorted thoughts and destructive behaviors and facilitate the process of change. They also learn about nutrition, the process of recovery, relapse prevention, assertiveness techniques, coping skills and other important topics.